经颈静脉肝内门体静脉分流术  

Transjugular Intrahepatic Portosystemic Stent Shunt

作　　者：简一平[1] 李学甫[1] 曹传平[1] 张秀荣[1] 褚建国[1] 陈肇一[1] 

机构地区：[1]北京空军总医院

出　　处：《胃肠病学和肝病学杂志》1997年第1期82-85,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的：评价经颈静脉肝内门体静脉分流术对肝硬化门脉高压症的疗效及优缺点。方法：先行预造影，经颈静脉插管至肝静脉，在肝内从肝静脉向门静脉穿刺，穿刺成功后选择性行胃冠状静脉栓塞，然后行球囊导管扩张建立分流通道，放置支架。结果：共２５例病例，２１例成功，４例失败。门脉压力从术前４０２±０３９ｋｐａ降至术后２５８±０２３ｋｐａ（Ｐ＜００１），门脉主干由１３４±０２４ｃｍ降至１１４±０２１ｃｍ（Ｐ＜００５），门脉主干血流速度由术前２３０±６５ｃｍ／ｓ增至术后４５５±１２３ｃｍ／ｓ（Ｐ＜００５），脾脏长径由１５８５±１７９ｃｍ缩小为１３８５±１８０ｃｍ（Ｐ＜００５）。食管静脉曲张消失１４例，明显减轻７例，６例伴顽固性腹水者术后明显减少。术后随访３～１５个月（平均１０个月），随访期间５例发生肝性脑病，３例分流通道发生明显狭窄（内径缩小０３ｃｍ以上），再出血及再发顽固性腹水各一例。结论：ＴＩＰＳＳ对迅速缓解门脉高压症，解除出血危险性是一种比较好的方法，近期疗效满意。但术后肝性脑病和分流通道发生狭窄值得重视。Aims:To evaluate the therapeutic efficacy of transjugular intrahepatic portosystemic stent shunt(TIPSS)on liver cirrhosis with portal hypertension. Methods:Twenty five cases of TIPSS were performed from July of 1993 to July of 1994, of whom 22 were male,3 female with mean age of 46.7 years (range 30～66).All patients had liver cirrhosis with portal hypertension and varices, 15 patients had recurrent bleeding for gastroesophageal varices,asctes were 6 cases.Resuits:Shunts were successful in 21 of the 25 patients (84.0%),and no death was due to the procedure.The diameter of the shunt was 8 to 10mm.the average portal vein pressure significantly dropped from 4.02±0.39 kpa to 2.58±0.23kpa (P<0.01).and the diamefer of the portal Vein redaced from 1.34±0.24cm to 1.14±0.21cm (p<0.05) Doppler ultrasound revealed that the maxium blood flow velocities in the main potal vein increased from 23.0±6.5cm/s to 45.5±12.3cm/s (P<0.05),and variceal hemmorrhage and ascites were effectively controlled after the procedure.The mean follow up time in the successful cases was 10 months (range 3～15).The shunt patency was determined with color Doppler ultrasound,and the narrow of the stent diameter(<0.3cm)was found in 3 patients,and recurrent bleeding and ascites in 1 patients respectively,and encephalopathy in 5 patients. Conclusions:TIPSS is a safe and effective method for portal decompression in the treatment of variceal hemorrage but the encephalopathy and stent narrow should be noted after TIPSS.

关 键 词：金属支架 肝硬变 门脉分流术 

分 类 号：R657.31[医药卫生—外科学]